HomeMy WebLinkAbout19-21706 CITY OF ZEPHYRHILLS
5335-8TH STREET Z.
j (813)780-0020 2106
BUILDING PERMIT
PERMIT INFORMATION'. LOCATION INFORMATION
Permit Number: 21706 Address: 38539 CRESCENT AVE
Permit Type: RE-ROOF ZEPHYRHILLS, FL. .
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: MOBILE HOME-PARK . Lot(s): Block: Section:
Square Feet: Subdivision: OAKSIDE MHP
Est.Value: Parcel Number: 02-26-21-0020-00300-0010
Improv. Cost: 15,839.00 OWNER INFORMATION
Date Issued: 9/04/2019 Name: OAKSIDE MHP-WILLIAM ZACK
Total Fees: 180.00 Address: 38539 CRESCENT AVE
Amount Paid: 180.00 ZEPHYRHILLS,FL. 33542
Date Paid: 9/04/2019 Phone: (813)782-2018
Work Desc: REROOF TP.O (CLUBHOUSE)
CONTRACTORS APPLICATION FEES
A. BARTLETT ROOFING & CONSTRUCTI REROOF RESIDENTIAL 180.00
Ins ections Required
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP
FINAL
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONT OR SIGNATURE PERMIT OFFI R
ERMIT EXPIRES IN ' MONTHS WITHOUT APPROVED INSPECTION
CAL SPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received
L.LL 3321=331=3= Phone Contact for Permitting r(
............... ........... ............... . ................7
Owner's Name �t xi
NW Lone umber
Owner's.Addressl z: "K, (—',r eS, .ef A-ue-- Owner Phone Number
Owner Phone Number
3:3-i5y 2L
JOB ADDRESS cLp--sc-e,-f- LOT#
SUBDIVISION PARCEL ID#1. 0.) %-d/ 06o10603C)000 /L
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTRR ADD/ALT SIGN' DEMOLISH
e INSTALL REPAIR
PROPOSED USE Q SFR 0 �COMM OTHER I
TYPE OF CONSTRUCTION Q BLOCK Q FRAME STEEL =
DESCRIPTION OF WORK 3 q—'
UkIbe-) 0-6
BUILDING SIZE SO FOOTAGE S S HEIGHT
BUILDING 6, 'K3 VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL AMP SERVICE DUKE ENERGY W.R.E.C.
=PLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ► Z,1 '706
=GAS ESP ROOFING Q SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA r---1YES NO
............
BUILDER
Ar.(Za cHqff go
REGISTERED N FEE CURRtt, JWN
COMPANY
. ,SIGNATURE--,(—
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED L_Y_LN-_j FEE CURREN
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN N
Address License#1
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN LILNLJ
Address License#
HHHH"H
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Build ing,plans;(1)set of Energy Forms,R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Silt Fence installed,
Sanitary Facilities&1 dumpster;.Site Work Permit for subdivisions large projects
COMMERCIAL Attach(2)complete sets of Building'Plans plus a Life Safety Page,(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(-110)rworking days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Fa'cilities&1 dumpster.Site'Work Permit for all new projects.All commercial requirements mu.st meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
1 1.4 1 v I
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement tis_rpqqirgd.._(A/C upgrades over$7500)
Agent(for the contractor)or Power of Attorney(f6r.th6'6wner)would:,be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING
Reroofs if shingles Sewers Se`rvi6e"Upgr'a*d`es -A/6 '<,:Ferice!s(Plot/Survey/Footage)
Driveways-Not over Col dfitbrif diipublic roadways..needsi ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions",-
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with.any
applicable deed restrictions. . , . I
UNLICENSED CONTRACTORS:AND CONTRACTOR-RESPONSIBILITIES: if the o*' r'i'et has hired a contractor or
contractors to-undertake work, they may-be,required to be licensed.in accordance with state and local regulations: :If the
contractor is not licensed as required by law, both the owner and contractor may be cited-for a misdemeanor violation
under-state law. If the-owner or=intended-contractor are uncertain as.to.what licensing requirements may apply for the.
intended work, they are advised to contact the Pasco County Building Inspection Division Licensing Section at 727-847-
8009. -Furthermore, if-the owner has'hired a 'contractor or contractors,. he,is advised to have the contractor(s)i sign
portions of the "contractor Block" of this application for which they will be-responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION,IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of-new buildings, change-of
use in existing buildings, or expansion of existing buildings,as specified in;Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may-be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or-final power release. If the project does not involve a certificate of occupancy,or
final power-release,,the fees must be.paid prior to permit issuance. Furthermore, if.Pasco County Water/Sewer Impact
fees are-due,-they must.be paid-priorto permit issuance in accordance,with applicable Pasco County ordinances:
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes,aw-amended): If valuation of work-is$2,500.00 or more, I
certify that 1, the applicant, have''been provided-with a copy of-the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above,described document.and promise in good faith to
'deliver it to the"owner"prior to commencement.
CONTRACTORIS/OWNER'S-AFFIDA.V,IT:A certify that all the information in this application-is accurate--and that all work
will be done in compliance with all applicable,laws regulating construction, zoning and-land development. Application is
hereby made to obtain a permit to do work'-an'd"installation as indicated, I certify that no work or installation has
commenced prior-to.issuance.of a permit and that all work will be performed-to.meet'standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,WaterMastewater Treatment.
-Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalig, Docks, Navig6bleWaterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater. Treatment,
Septic Tanks.
US'Environm6ntal Protection Ager(cy-Asbestos-abatement.
Federal Aviation Authority-Runways.
I under9tand-that the.following-restrictions apply to the use of fill:
- Use of-fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material is,to be used in Flood Zone "A", it is understood that a drainage plan addressing a
.compensating-volume" will be submitted at time-of permitting which is prepared-by a professional engineer
licensed by the State of Florida. wall,
- If the-fill-material is.to be used in Flood-Zone "A" In connection with a permitted building using stem
construction,,I certify that fill will-be-used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill-is found to adversely affect adjacent properties-' the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre Which:,are elevated:by,fill,an engineered drainage plan-is required.
If I am the-AGENT FOR THE OWNER, I promise in good faith to inform the owner of-the permitting conditions set forth in
this,affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing,-signs, wells, pools, air conditioning, gas; or other installations,not specifically included in.the,application. A
permit issued shall be construed to be,a license to proceed.with•the work and not as authority to violate, cancel, alter,.or
set aside any provisions of the technical codes,-nor shall issuance:of a permit prevent the Building Official from thereafter
requiring a correction of errors im plans, construction or violations of any codes. Every permit issued shall become invalid
unless-the work authorized by such:permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time-the-work-is-commenced. An extension
may be requested, in writing, from the Building Official fora.period not to exceed ninety (90) days and will demonstrate
justifiable cause for the-extension. If work ceases for ninety-(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE.OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO-YOUR PROPERTY. IF YOU`INTFND TO OBTAIN FINANCING;CONSULT
WITH.YOUR LENDER'OR AN-ATTORNEY BEFORE RECORDING YOUR NOTICE OF,COMMENCEMENT.
FLORIDA JURAT(F.S.117.03)7------ Of
OWNER OR AGENT CONTRACTOR— ov.7
Subscribed and sworn to(or affirmdd)before,me this Subscribed nd sw n I {or rr#(li}:before,,me.thIs
by y- - - - ,- - =1-
Who is/are personally known to me or has/have produced ers nalfFy- to me or has/have-kodilbied1
as identification. -.,as.,Idenb
Notary Public Lot ____Notary Public
Commission No. Commi
JACQUELINE B
'AMM
Name of Notary typed,printed or stamped Name of N r 915,
• r.,wx w Thru T rey Z 202�
....... 7 FA Insurance 800.385.7019
///A. BARTL.ETT
ROOFING & CONSTRUCTION SERVICES, LLC
38408 3rd Ave. I Zephyrhills, FL 33542
(813) 782-5585 !,331q
Email: Coreyh@abartlettroofing.com Lic. #CCCIARMN
RESIDENTIAL • COMMERCIAL . MOBILE HOMES
LICENSED - INSURED - BONDED
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Date
Name OA- 5� �� l��d �� )eov►,,e
Address
Phone
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FPS 06 o 1-I90 - .l 58311,
THANK YOU
Your Business is Appreciated
Payment upon completion unless previous arrangement made.Warranties pertain to original owner.
All arrangements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation insurance.Customer is liable for any charges incurred in collecting this bill. Total'.
0artifted ature Date
WeetherSmPPer'R�flnB Camracmr
INSTR#20191.35392 OR BK 9953 PG 3937 Page 1 of 1
08/09/2019 04:41 PM Rcpt:2080175 Rao:10.00 DS:0.00 IT:0.00
Nikki AlvarezSowles,Esq.,Pasco County Clerk&Comptroller,ad Interim
PWmit No. ParoN ID No O 2 o)(O�p I n6D6 o n/a
NOTICE OF COMMENCEMENT
THE UNDERBIGNED Iwa y glues narks that h provmwnt wW be made to oabbt reM Property,and In accordance with Chapter 713,Florida SWIvites,
the Now"kdormaft is provided in this Nofla of commencement
t, DesplpnWl of Ptoyerpr.Parcel IdaAlEatlml Pb.d (o
FJ�
-2.
Gamno oesalpUmi of"roverflant ll1�,,—e—7 r'1)12.4 dy d' e 1C,S�r k C
A Owner,lelbrmstbn or Lowe IMonnatlon If gat Lessee oontrecl ed for the Improvement
Into M Property
Name of Fee BtgrPb Ttllehsidu: -
pfddfinentfromO-M!" ) ..
Add1M
4. COrlbyctoc
- 7DNf�1 jr Mf fib C Nw'.1 Pitr rud
raw Oayr T� I stela
CordnCoft T'*PMM No.
tf. 8urehl:
NM -
Addmn' Pita
Amalyd of Bond:1 Tebphone No.:
b f,.endor: Name
Adder State
Landers Telepflota No.:
1. Paears wldrbr the Stab of Florida designated by the'&mw u;=whom noYlow or other doe nwits may be seared as provided by
SaWon 713.13(txe)(71,lir"481005:
Name
AddM" Crb State
Telepflone Number o}Daeipnsbd Peron. .
0. In eddttlon to htrttutl,the asirrer dagrrotw � .� .; of---
to reaeAie�oopji of Ste lbrrofs Nods a•provided N 8tdbrr 713.13(t)@).FbAda t3tabrtea.
Tebpttom Number of Prw or En*Dafgnabd by Owner;
aB#jgW date of Noffao of CwMenemnad(the eguatioon date may not be before the earnpNon of oo*Uaton and m,al Mra i to tho
eoird�aroq out wa W ant ytartrom tat dM or ndmaft umps p ott(adm den is spooned):
WARNING TID OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMAENCEMENT
ARF.CONSIDERED IMPROPER PAYMENTS UNDER CHARIER 713 PART 1 8ECTION 713.13 FLORIDA STATUTES AND CAN -
RESULT iN YOUR PA�N3 Trl/iCE FOi!►Ao4O: Nl74TS TO YOUR PROPt�RTY. A NoncI OF COMMENCEtNENt MUST BE
RECORDED AHD POSTED ON THE JOB StTE BEFORE THE FIKS f INSP8CT10N IF YOU INTEND TO OBTAIN MAHCiNG,COMEr.A.T —
WgT}I YOUR LENDER GRAN ATTORNEY BEFORE COf1f7�tlCIHO WORK OR TtECORDI)�3 YOUR NOTICE OF CM0AENCMMT-
Undai panNty of o��ad1�tuy I darLre that I have triad the ro!eg?Mg notbi enoanert and ttret the taOe ab bd&mein are true to the bat
of my fatvMt�e'u+d 1se�L - - _ ..
STATE OF FLORI
COUNTYOF PAS CINTMIA M JEWELL
E MY commis #00025898 a. or leased,or efn or LAWhorked
EXPIRES A6'9 st 29,2020-
Billinatorl^eTkWOMoo
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sa' ftVZM0fMUftttbl.e6g.,oflieer,mates,aftmoy In faep for
. - ... .. - . ( enbeha whnmfnancrrntwas�weiddd).
p!niao.ny rrnoitm p ga woauasd Mtenmm�on�' Notary t3rprrawro .
TYA!otldtntillcoft Produced =`� Nmp(P±hrd
®� G9RCQp�b° STATE OF.FLORIDA,COUNTY OF PASCO .
THIS IS 1*0 CERTIFY THAT THE FOREGOING IS A .
TRUE AND CORRECT COPY OF THE DOCUMENT
A ON FILE OR,OF PUBLIC RECORD IN THIS OFFICE
�e �z WI SM "HJ4Nt A 'OFFICI LSEALTHIS
° c� D Y OF 2.
�� OBE L OOII�f�TRC7LLEf
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m �� BY - —_ MTHTY CLERK
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SCIS Home ;tog Tn User Registration t Hot Toptcs Submit Surcharge Stats&facts Pablicailons :` Contatk Us SCIS Site Map r. itnks Search
d.
Product ApprovalUSER:Public User
1 .4aysnw.ai ns>Pmducton Anullctton Srarsh;>AD-11catforl'lsr->Application Detail
:k �= FL* FL5027-1113
Application Type Revision
Code Version 2017
Application Status Approved
*Approved by DBPR.Approvals by DBPR shall be reviewed and ratified by
the POC and/or the Commission if necessary.
Comments
Archived
Product Manufacturer GAF/LL Building Products,Inc sub of GAF
Address/Phone/Email 1 Campus DrJv LL WORK SHALL
mstleh@gaf.c COMPLY Parsippany,N3600ES FLORIDA BUILDING WITH
coop.(800)766-341 PREVAILINGo rIO�AL ELECTRIC CODED THE�CITYOFZEP PH
INANCES I�YR�1I1�,$Authorized Signature Michael Stieh ORD
mstieh@gaf.com
Technical Representative Steve Boehling
Address/Phone/Emall 295 McKoy Road
B rgaw,oehlin NC 2f.co REVIEVi/LSAT
sboehling@gaf.com
CITY 6F�EPH
Quality Assurance Representative PLAN EXAMINER
Address/Phone/Email
Category Roofing
Subcategory Roofing Accessories that are an Integral Part of the Roofing System
Compliance Method Evaluation Report from a Product Evaluation Entity
Evaluation Entity Miami Dade BCCO-EVL
Quality Assurance Entity Miami-Dade BCCO-QUA
Quality Assurance Contract Expiration Date 11/10/2020
Validated By Miami-Dade BCCO-VAL
Certificate of Independence
Referenced Standard and Year(of Standard) Standard Year
TAS(100)(A) 1995
Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Method Method 1 Option C
Date Submitted 09/07/2018
Date Validated 09/21/2018
Date Pending FBC Approval
Date Approved 09/28/2018
Summary of Products
FL# Model,Number or Name Description
5027.1 Master Flow@ 12"Galvanized Wind 12"galvanized Turbine Roof Ventilator(externally braced in
Turbine-Externally Braced-Dual mill finish and in colors)
Bearing Construction(GC12EF)
Limits of Use 'Installation Instructions
Approved for use in HVHZ:Yes a=S13 U F RW17=1.04;f f'g .off
Approved for use outside HVHZ:Yes Verified By: Miami-Dade BCCO-EVL
Impact Resistant:N/A Created by Independent Third Party:
Design Pressure:N/A Evaluation Reports
Other:Master Flow@ 12"Galvanized Wind Turbine- FLS027 R13 AE NQA No 17-0221.04 GC12EF.odf
Externally Braced-Dual Bearing Construction(GC12EF)shall ,
:not be installed on roof mean heights greater than 33 feet
and these vents are approved for asphaltic shingle roofing per
Miami-Dade NOA 17-0221.04.The Master Flow@ 12"
Galvanized Wind Turbine-Externally Braced-Dual Bearing
Construction(GC12EF)complies with the HVHZ of the Florida
Building Code.
t5027.2 ;Master Flow@ Attic Exhaust Vent- 10'long aluminum ridge vent-in embossed mill finish and
:10 ft.Aluminum Ridge Vent colors
(AR10H)
Limits of Use Installation Instructions
Approved for use in HVHZ:Yes FL5027 R13 II AM X0,17-0321,07 AR109-4 V
Approved for use outside HVHZ:Yes Verified By: Miami-Dade BCCO-EVL
Impact Resistant:N/A Created by Independent Third Party:
Design Pressure:N/A !Evaluation Reports
Other:Master Flow@ Attic Exhaust Vent-10 ft.Aluminum 827 R13; AF mak 00 g-Q I-ga bRY6&ti
Ridge Vent(ARIOH)shall not be installed on roof mean
heights greater than 33 feet per Miami-Dade NOA 17-
0321.02.The Master Flow@ Attic Exhaust Vent- 10 ft,
Aluminum Ridge Vent(AR10H)complies with the HVHZ of the
,Florida Building Code
5027.3 Master Flow@ Green Machine'" Roof Mounted Solar Powered Attic Ventilator
Solar-Powered EcoSmart Roof Vent
i(PRSOLARI)
Limits of Use Installation Instructions
Approved for use in HVHZ:Yes Flaw 7 R13 1A BEOA NO lkmjZ-18,RIiS0ti M Wd
Approved for use outside HVHZ:Yes poffiffffigmr,11
Impact Resistant:N/A Verified By: Miami-Dade BCCO-EVL
Design Pressure:N/A Created by Independent Third Party:
Other:Master Flow@ Green Machine•"Solar-Powered Evaluation Reports
EcoSmart Roof Vent(PRSOLARI)is approved for installations FL5027 R13 AE MA NO 15-0812,18 PRSOLAR3 And
of asphaltic roofs with mean roof heights no greater than 33 P$#fYIPIRIt#LodF
feet per Miami-Dade BCCO NOA 15-0812.18.Master Flow@
Green Machine'"Solar-Powered EcoSmart Roof Vent
,(PRSOLARS)complies with the HVHZ of the Florida Building
Code
5027.4 Master Flow@ Slant-Back Roof Static Roof Louver
Louver(SSB960A)
.Limits of Use Installation Instructions
i Approved for use in HVHZ:Yes giilr7 M 0 17-20MR2-5959W sum sam
Approved for use outside HVHZ:Yes vem
Impact Resistant:N/A Verified By:Miami-Dade BCCO-EVL
Design Pressure:N/A Created by Independent Third Party:
Other:Master Flow@ Slant-Back Roof Louver(SSB960A) Evaluation Reports
shall not be installed on roof mean heights greater than 33 F1_%27 R13 A£ 17-1020.02-SSB960 Slant!Sack Static
feet and are to be installed on asphaltic shingle roofing per F
,Miami-Dade NOA 17-1020.02.The SSB960 Static Roof Louver
(complies with the HVHZ of the Florida Building Code.
Bade etct
Contact Us::26D1 Blair Stone Road.Tallahassee FL 32399 Phone:850-487-1824
The State of Florida Is an AA/EEO employer.Coovriaht 2007-2013 State of Florida.::Privacy Statement::Accessibility Statement::Refund Statement
Under Florida law,email addresses are public records.If you do not want your e-mail address released in response to a public-records request,do not send electronic
mall to this entity.Instead,contact the office by phone or by traditional mall.If you have any questions,please contact 850.487.1395.-Pursuant to Section 455.275
(1),Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The
emafle provided may be used for official communication with the licensee.However email addresses are public record.if you do not wish to supply a personal address,
please provide the Department with an email address which can be made available to the public.To determine if you are a licensee under Chapter 455,F.S.,please
click haL.
I'mill
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: /�'j
Date Received:
Site: 3 &5-3?
Permit Type: �� lk&4—
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit and/or plans.
Ka in Sw' —Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)